Breast implant-lymphoma connection debated

Although breast implants are without a doubt the most extensively studied medical devices on the market and are widely regarded as safe, a new report is raising questions about a possible connection between implants and a rare form of non-Hodgkin's Lymphoma called ALCL. Dr. Garry Brody, a Professor Emeritus of plastic surgery at USC, has been collecting a database about these rare cases, now totaling 25. Importantly, the tumor occurs in the scar capsule around the implants, not in the breast, and appears to be associated with a specific type of textured implant surface. A more important distinction is that these tumors behave in a very benign fashion and are highly curable by surgical removal of the capsule. This suggests that they are actually something other than ALCL despite the fact that they have all of the features of it under microscopic examination.
Although any report of cancer and breast implants is likely to be sensationalized, a cautious approach would be prudent in interpreting this story. In addition to the unanswered question of whether or not this is really a cancer, the incidence among women with implants appears to be in the range of one in a million, which could only be characterized as extremely rare. There will likely be other reports coming forth as the story is publicized, but given the number of women worldwide with implants, it is likely to remain a rarity. So in the good news column, place the fact that it is highly curable, and if it does have a causative link, it is to a type of implant that is less frequently used now (I have been using exclusively smooth-surface implants for augmentation for 15 years.) To keep this in perspective, it is the drive to the plastic surgeon's office that is the most dangerous part of breast implant surgery, not the implants.

Breast implants in athletic women

Women athletes arguably have more obstacles to overcome than their male counterparts, title 9 and lack of career options in professional sports notwithstanding. Lower natural levels of muscle-building hormones such as testosterone means even harder work to develop strength, and the lean build that is beautiful in so many ways becomes less feminine at the same time. There are several versions of attractive female figures, but for many athletes the desire to have at least a few womanly curves is natural. The choice to have breast implants is both personal and justifiable, yet opinions of the many seem to be given credence.
That is probably part of the reason why there has been so much media coverage of the decision of Australian hurdler Jana Rawlingson to have her breast implants removed. Apparently she has decent odds of medaling in the next summer Olympics but felt that the implants might get in the way. Frankly that is a little bit hard to imagine unless they were large to begin with, which is not a typical choice for an athlete in the first place. I wish her luck but if she does well it will be because of her dedication and training, not because she had her implants out.
The question of implants in athletes deserves serious attention from plastic surgeons who breast augmentation, though, because there are unique issues that need to be addressed. Ordinarily, with low body fat and small breasts, submuscular placement of the implants gives a more natural look. However, with a lot of muscle development that just isn’t a good choice for a number of reasons, some obvious and others not. I have been using an in-between option called subfascial implant placement (fascia pronounced like fashion) in cases like these. This provides support for the implants and more natural curves. Combined with small, usually low-profile implants, this results in more real-looking and proportionate breasts. Whether these breasts are truly more aerodynamic is another question.

Post-operative breast implant massage: Does it help?

A frequent question we get about breast augmentation is whether or not post-op massage is recommended or potentially beneficial. One popular website, BreastImplants411.com, has created a checklist including a question about implant massage; patients considering breast augmentation are supposed to ask specifically about it. And plastic surgeons seem to be split on the question, with some strenuously advising it and others cast as non-believers. With such contradictory views, what is an informed person supposed to make of it?
The main idea behind it originated in an era when capsular contracture, a hardening of the scar capsule around the implant, was much more common. Plastic surgeons were trying anything that might make a difference, and cases of contracture were sometimes treated with a fairly brutal procedure called a “closed capsulotomy” which consisted of squeezing the breast hard enough to make the scar capsule rupture. Although patients might run out of the clinic in tears, the breast would be softer (for a while.) So the thinking was that perhaps squeezing the breasts on a regular basis, especially during the healing period, could prevent the scar from contracting in the first place.
In retrospect, it was a fairly naive notion, but there wasn’t much else to offer because the causes of capsular contracture were so poorly understood at that time. So it became entrenched as a routine practice and no one bothered to do a clinical study to see whether it did any good. In fact, to this day no such study has been published. Evidence now points to bacterial biofilms, invisible contaminants caused by miniscule numbers of otherwise harmless germs, that cause a reaction in the scar that encloses the implant. Better surgical techniques and better implants than the ones used 25 years ago appear to be the important variables.

So at this point we still have no objective evidence that post-op implant massage makes any difference in capsular contracture. There are certainly cases where swelling tends to push implants up and massage can be helpful in getting them to settle, but that is only sometimes the case. So the question shouldn’t be “Do you recommend massage?” but if so, “Why?”

The cup size question

One of the most common questions we get is what breast implant size is needed to achieve a certain cup size. Real Self, the website where people can ask questions of plastic surgeons, has a question on that almost daily. The problem is, there is no simple answer because the cup size system of bra sizing is just not very scientific. It's an indirect measurement of the breasts, inherited from more modest times. The modern bra dates to about 1914, though the oroginal design was intended to flatten the breasts as the "flapper" style was in. The inventor of the bra, Mary Phelps Jacob, sold the idea to the Warner Bros. Corset Company for $1500. In the 1930's, when a more voluptuous figure was in fashion, Warner Brothers introduced the familiar A-D cup system. They reportedly made millions on their original investment.
Breast implants, now the most popular cosmetic surgical procedure, come in a variety of dimensions and sizes, but cup size is a combination of chest size, breast size, and shape. For that reason, there is no single implant size that correlates to a given cup size. I always recommend that the desired cup size should be a starting point, and so we have patients use a bra of that size and try samples tucked into the bra. In the end it's best to pick what just looks right.